Tight Regulation and Hypoglycemia

[Brad and Chowder]

Hi everyone, my cat Chowder has been tightly regulated with twice-daily Lantus for a bit under two months now; I do not have a spreadsheet with his glucose levels, but I can say that his numbers on a human meter (the ReliOn Micro) most often range from 60 to about 140, with a very occasional mid 50 or so (but never lower) at his nadir. His pre-shot levels are often in the low 100s, sometimes slightly lower, and his dose is usually .75 units of Lantus. Even when he was unregulated, with levels above 200 and even 300, I always feared hypoglycemia way more than I think was appropriate at the time, and even now, I believe I allow it to interfere with my sleep. So, a couple of questions:

1.) At night, I often give Chowder a shot around 8:30 PM, because I want to be around for several hours. Lately, I've done his final blood check at midnight or even 12:30 AM, when it is often somewhere in the 80s or 90s. I then go to bed, but the worry of him getting too low has kept me up later in the night...given that he always eats before I go to bed, and that I leave plenty of food out, am I worrying too much overnight?

2.) Is severe hypoglycemia only possible if both a cat's blood sugar level is extremely low AND they haven't eaten? In other words, if Chowder eats his wet food every two or three hours on his own, is he basically protected against hypoglycemia? Not that his numbers ever get below 50, as I mentioned, but I'm curious if the fact that he eats so regularly means I have less reason to worry.

Thanks so much for any input!

 

[Olive & Paula]

Brad, hello and welcome.

I can't tell you to worry or not worry. I can only say what Smokey does. He is fed every 3-4 hrs. I have an auto feeder for overnight. I'm all for uninterrupted sleep. I don't get up to test him, if I happen to be up I will but it's rare. I'm home during the day. Sometimes when I test anywhere in between shots I will get a 40 or god forbid lower. And that's with him eating every 3-4 hrs without fail. It can happen.

If your ever up during the night grab a test. Maybe set an alarm on some nights. Sounds like Chowder is pretty stable whereas Smokey is not at all. A few extra tests here and there wouldn't hurt to give you peace of mind. Could be one day Chowder will decide this dose is to much.

 

[Elizabeth and Bertie]

2.) Is severe hypoglycemia only possible if both a cat's blood sugar level is extremely low AND they haven't eaten? In other words, if Chowder eats his wet food every two or three hours on his own, is he basically protected against hypoglycemia?

Hi Brad,
Hypo is caused by too much insulin.
In a minor case it may be that eating wet food could remedy the situation. Sometimes a caregiver will monitor and will just feed low carb wet food at intervals to keep the blood glucose levels up until the kitty is past the peak (lowest BG) of the cycle.
But sometimes low carb food isn't enough to protect them.
Sometimes cats need higher carb food or glucose/karo/syrup in order to get the numbers up and keep them safe.
Long story short, you cannot assume that leaving low carb food out will keep a cat safe. Some cats don't even 'recognise' that their BG is dropping low....
.

 

[Tuxedo Mom]

You had some excellent information already. Just to add...even with a higher preshot number, glucose levels can still drop to very low levels. For example, with the AT2 pet meter, which reads higher than a human meter, one of my kitties has dropped from a preshot of 281 to 45 four hours later. My other kitty has dropped from a preshot of 263 to 49 six hours later. Both of them are on Levemir long acting insulin.

What insulin are you using. How fast insulin works and when the lowest number (nadir) is deoends on the insulin type.

 

[Vyktors Mum]

Here's the instructions to set up a spreadsheet http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/ without seeing Chowders numbers it is impossible to say whether or not there might be some times that Chowder is at risk and point those out to you or whether how you're doing things is perfectly safe. E.g. You do your last PM test at +3.5 to +4 hours after the shot but without being able to see his data to understand when his onset and nadir usually are, or how far he's dropped on a particular night I couldn't tell you if that was safe for him or not.

Even the last couple of weeks worth of data would help - a month would be even better.